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Due to differences in the circulation of influenza viruses, distribution and antigenic drift of A subtypes and B lineages, and susceptibility to infection in the population, the incidence of symptomatic influenza infection can vary widely between seasons and age-groups. Our goal was to estimate the symptomatic infection incidence in the Netherlands for the six seasons 2011/2012 through 2016/2017, using Bayesian evidence synthesis methodology to combine season-specific sentinel surveillance data on influenza-like illness (ILI), virus detections in sampled ILI cases and data on healthcare-seeking behaviour. Estimated age-aggregated incidence was 6.5 per 1000 persons (95% uncertainty interval (UI): 4.7–9.0) for season 2011/2012, 36.7 (95% UI: 31.2–42.8) for 2012/2013, 9.1 (95% UI: 6.3–12.9) for 2013/2014, 41.1 (95% UI: 35.0–47.7) for 2014/2015, 39.4 (95% UI: 33.4–46.1) for 2015/2016 and 27.8 (95% UI: 22.7–33.7) for season 2016/2017. Incidence varied substantially between age-groups (highest for the age-group <5 years: 23 to 47/1000, but relatively low for 65+ years: 2 to 34/1000 over the six seasons). Integration of all relevant data sources within an evidence synthesis framework has allowed the estimation – with appropriately quantified uncertainty – of the incidence of symptomatic influenza virus infection. These estimates provide valuable insight into the variation in influenza epidemics across seasons, by virus subtype and lineage, and between age-groups.

Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s.

Method

A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985–1989, 1995–1999, and 2005–2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios.

Results

The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100 000 person-years in 1985–1989 to 6.1 in 1995–1999, and 3.2 in 2005–2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 1 00 000 person-years in 1985–1989, 7.8 in 1995–1999, and 6.0 in 2005–2009.

Conclusions

The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.

It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.

Method

A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.

In 2009 two notable outbreaks, Q fever and the novel influenza A(H1N1)pdm09, occurred in The Netherlands. Using a composite health measure, disability-adjusted life years (DALYs), the outbreaks were quantified and compared. DALYs were calculated using standardized methodology incorporating age- and sex-stratified data in a disease progression model; years lost due to disability and years of life lost were computed by outcome. Nationally, influenza A(H1N1)pdm09 caused more DALYs (24 484) than Q fever (5797). However, Q fever was 8·28 times more severe [497 DALYs/1000 symptomatic cases (DP1SC)] than A(H1N1)pdm09 (60 DP1SC). The A(H1N1)pdm09 burden is largely due to mortality while the Q fever burden is due primarily to long-term sequelae. Intervention prioritization for influenza should support patients in a critical condition while for Q fever it should target immediate containment and support for patients with long-term sequelae. Burden estimates provide guidance for focusing intervention options during outbreaks of infectious diseases.

The effect of conventional process parameters on the deposition of μc-Si:H solar cells is reviewed. Then, an approach to solar cell optimization is presented in which hidden, internal parameters are adjusted rather than conventional, external process parameters. The investigation focuses on deposition at low H2 dilution ratio and low total gas flow. A hidden parameter is identified through time resolved optical emission spectroscopy on SiH emission: Transient depletion of the SiH4 source gas leads to uncontrolled deposition conditions during the first 90 s after plasma ignition. There hardly is any effect on plasma properties and deposited film properties for the remainder of deposition after the transient depletion phase. As demonstrator a 9.5 % efficient single junction μc-Si:H solar cell was deposited from a pure SiH4 flow. A reinterpretation of the role of H2 dilution is discussed.

Large Q-fever outbreaks were reported in The Netherlands from May 2007 to 2009, with dairy-goat farms as the putative source. Since Q-fever outbreaks at such farms were first reported in 2005, we explored whether there was evidence of human outbreaks before May 2007. Space–time scan statistics were used to look for clusters of lower-respiratory infections (LRIs), hepatitis, and/or endocarditis in hospitalizations, 2005–2007. We assessed whether these were plausibly caused by Q fever, using patients' age, discharge diagnoses, indications for other causes, and overlap with reported Q fever in goats/humans. For seven detected LRI clusters and one hepatitis cluster, we considered Q fever a plausible cause. One of these clusters reflected the recognized May 2007 outbreak. Real-time syndromic surveillance would have detected four of the other clusters in 2007, one in 2006 and two in 2005, which might have resulted in detection of Q-fever outbreaks up to 2 years earlier.

Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.

Method

We conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.

Results

The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=−0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.

Conclusions

It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.

A sero-epidemiological survey, using an indirect immunofluorescence test for IgG against Coxiella burnetii (phase II), was carried out in the Netherlands. Serum samples taken in 1968, 1975, 1979 and 1983 were tested. Occupational groups with a supposedly high risk of infection (veterinarians, residents of dairy farms and taxidermists) showed a significantly higher percentage of seropositives than defined controls. The percentage of seropositive amateur wool spinners was significantly higher than that of the controls from the same region. Since 1968 there has been no increase in the percentage of infected persons, indicating that, contrary to earlier assumptions, Q fever has been endemic in The Netherlands for a long time already. The increase in numbers of notified cases of overt Q fever is considered to be the result of the recent introduction of a sensitive indirect immunofluorescence test for IgM antibodies against C. burnetii. Antibody percentages in all age classes between 1 and 64 years were much alike, suggesting that most infections occur in early childhood. This is in accordance with the finding that 35% of our patients are younger than 3 years. The possibility of infection related to childbirth and lactation is discussed.

We analysed long-term epidemiological trends in influenza-like illness (ILI) in The Netherlands and used an ecological analysis to estimate its relationship with age, influenza vaccination, and virological aspects. This study used data from weekly ILI consultation reports from sentinel general practitioners (1986/1987 to 2006/2007), virological data from sentinel ILI patients (1992/1993 to 2006/2007), and data for influenza vaccine uptake (1991–2005). The incidence of ILI consultations, although varying during the study period, was estimated to decrease in the total population by 12·2/10 000 persons each season (95% CI 8·6–15·9). Uptake of influenza vaccination in people aged ⩾65 years (elderly) increased from 28% in 1991 to >70% since 1997. ILI incidence in the elderly declined by 1·7/10 000 persons (P=0·05) per percentage vaccine uptake per season. The decline in ILI incidence over the last 20 years could be related to the increased vaccine uptake. However, insufficient data were present to assess the impact of other potential contributing factors, such as diminished fitness of influenza viruses and changes in consulting behaviour.

The effect of process parameters on the plasma deposition of μc-Si:H solar cells is reviewed in this article. Several in situ diagnostics are presented, which can be used to study the process stability as an additional parameter in the deposition process. The diagnostics were used to investigate the stability of the substrate temperature during deposition at elevated power and the gas composition during deposition at decreased hydrogen dilution. Based on these investigations, an updated view on the role of the process parameters of plasma power, heater temperature, total gas flow rate, and hydrogen dilution is presented.

A performance test of pigs was conducted according to an adapted version of the ‘Kielanowski system’ in which the feeding level and the termination point of the test period were changed. A total of 119 pigs of six genotypes (participants in the Commercial Pig Evaluation in The Netherlands, 1981) averaging 22 kg weight, were fed for 17 weeks on a scheme according to days on test. The regime was such that not all the pigs could consume their total allocation of food. The fast-growing pigs were expected to be more efficient and therefore the leanest.

Forty-eight pigs consumed their total food allocation, whereas the remainder left an average of 5·89 kg food. Pigs that consumed their total allocation of food had a significantly better food conversion ratio (0·07 kg/kg; P < 0·01) and a higher daily gain (33 g/day), but they had significantly less lean (10 g/kg; P < 0·05) in their carcasses than pigs that could not consume their whole allocation. The ranking of genotypes for average daily food intake closely agreed (rs = 0·94) with the ranking in another trial with ad libitum feeding, which points to the possibility for selection on food intake capacity in the proposed system. For the other variates, the ranking correlations were moderate.

Among the pigs that consumed the total amount of food offered, a moderately strong relation (r = 0·70) was found between daily gain and lean tissue growth rate. With the system tested, it was not possible to determine leanness simply by weighing the pigs afterwards. Nevertheless, the results of the modified Kielanowski system show some interesting aspects which contribute to the design of a test system for a genetically unbiased comparison among pigs.

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